*5.2.2 Physical activity*

*Type 2 Diabetes - From Pathophysiology to Cyber Systems*

HbA1c [19] < 7% (53 mmol/mol), for most patients

complications)

complications and comorbidities

• Avoidance of hypoglycemia:

Blood pressure [18, 19] < 130/80 mmHg (≥ 65 years = 130–139/70–79 mmHg)

those at high CVR

• No smoking

• Triglycerides <150 mg/dl \*

• long term weight loss maintenance

• Healthy nutrition, caloric adjusted

• No/moderate alcohol intake

< 100 mg/dl - moderate CV risk

• Fasting/pre-meal glycemia = 80–130 mg/dl • Postprandial glycemia (1–2 hours) < 180 mg/dl

> 70% time in range (70–180 mg/dL/3.9–10.0 mmol/L) < 4% glucose range below 70 mg (3.9 mmol/L)

< 70 mg/dl and > 50% reduction - high CV risk < 55 mg/dl and > 50% reduction – very high CV risk

• Reduced glycemic variability (< 36%)

< 6,5% (48 mmol/mol), if the target can be achieved without hypoglycemia† (usually younger patients, short duration of diabetes, longer life expectancy, no

< 8% (64 mmol/mol), for patients with long-standing diabetes, complex glucose-lowering treatment including insulin, history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular, multiple

• Non-HDL-col <85 mg/dl in patients at very high CVR, and < 100 mg/dl in

• HDL-cholesterol >40 mg/dl in men and > 45 mg/dl in women \*

**Risk factors Therapeutic targets**

Lipids [12] • LDL-cholesterol:

Body weight [19] > 5–10% weight loss and

*Therapeutic targets in T2DM (adapted by [12, 19, 48, 49]).*

Lifestyle [19] • Physical activity

*ambulatory glycemic profile per day [19, 49]. \*Not a goal but indicates a lower risk.*

Fasting glycemia, postprandial glycemia, glycemic variability

[19]

in appropriate portion sizes. To ensure adherence and effectiveness, nutritional interventions should be individualized by meeting individual's needs, personal and cultural preferences, access to healthy foods, the pleasure of eating, and providing

*†Glucose range below 70 mg/dl in less then 4% of the measurements determined by continuous glucose monitoring or* 

Dietary interventions can reduce HbA1c with up to 2% [50]. Caloric intake should be adapted to maintain body weight control. General recommendations are to avoid saturated lipids and foods with a high glycemic index. The Mediterranean diet, the DASH diet (Dietary Approaches to Stop Hypertension), plant-based diets, are recommended for their proven benefits. Carbohydrates should come from foods rich in fibers: vegetables, legumes, whole grains, fruits. Lipids should be mainly monoand polyunsaturated and omega-3. Supplementation with minerals or vitamins is only recommended in case of deficiency. Hydration is important, with the selection of non-caloric drinks. Consumption of alcohol in moderate amounts is acceptable, but special attention should be paid to the risk of hypoglycemia, hyperglycemia and

additional caloric intake. Sodium intake should be <2,300 mg/day [50].

practical tools to implement the recommendations [50].

**284**

**Table 1.**

Most patients' recommended physical activity is at least 150 minutes/week, at least three times/week, moderate/high intensity, aerobic, 2–3 sessions/week of endurance and flexibility exercises. Reducing the time spent in sedentary lifestyle is also an important recommendation [50].
